TE_3_-_Attch_12._RSI-Interpol_FIPC_554_v._Apr_2018.pdf

NATIONAL BACKGROUND INVESTIGATIONS BUREAU

RSI REQUEST FORM

Electronic submissions must be saved and sent through the NP2 Secure Portal

REQUEST PRIORITY HANDLING:

*AGENCY SO I/SON: BUSINESS EVENT TYPE CODE (BETC): TREASURY ACCOUNT SYMBOL (TAS): ACCOUNTING #: *AGENCY IPAC:

DATE SUBMITTED TO NBIB: TOTAL NO. OF PAGES:

SEE INSTRUCTIONS ON THE REVERSE PAGE

*SUBJECT’S LAST NAME: *FIRST NAME : MIDDLE NAME: SUFFIX SUBJECT SOCIAL SECURITY # NBIB CASE#

INVESTIGATION HAS BEEN REPORTED VIA THE QUALITY ASSESSMENT REPORTING TOOL (QART). ENTER ASSESSMENT ID #:

*SUBJECT’S CURRENT CONTACT INFORMATION:

Address of Subject's Physical Location (For Contact) *SUBJECT'S PHONE #:

*SUBJECT'S EMAIL ADDRESS:

NOTE: Please ensure you select an item in the drop down box and enter an explanation in the text box below for each item needed. Additional items can be entered on page 2 & 3 of this form.

Include all information needed to conduct the follow up you want, such as: Issue to resolve; Addresses for, number, types of sources (Personal & Record); thresholds for financial follow up; type of public records. If additional room is needed to provide the details for the work requested, please use page 3 and ensure you reference the item number to which it pertains. For Example: Note 1: continue your explaination.

NOTES/WORK TO BE COMPLETED:

1.

2.

3.

4.

*SUBMITTER’S NAME: *SUBMITTER’S PHONE NUMBER: EXT:

*SUBMITTER’S EMAIL ADDRESS:

*=Required Field

PRIVACY ACT INFORMATION: This investigative request is in full compliance with the Privacy Act of 1974 and othe r laws protecting the civil rights of the person we are investigating. The information provided will be retained by the Office of Personnel Management and may be disclosed to the person being investigated or other federal agencies.

FIPC 554

(04/2018) nicole.t.hayes2 Highlight nicole.t.hayes2 Highlight nicole.t.hayes2 Highlight nicole.t.hayes2 Highlight nicole.t.hayes2 Highlight nicole.t.hayes2 Highlight nicole.t.hayes2 Highlight nicole.t.hayes2 Highlight nicole.t.hayes2 Highlight

FIPC 553 Instruction 8-2015 REV2 PDF